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General NPI Number Information
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NPI Number | 1205878758
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Entity Type | Organization
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Legal Business Name | ALBUQUERQUE AMBULATORY EYE SURGERY CENTER, LLC
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Dates
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Enumeration Date | 06/11/2006
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Last Update Date | 01/10/2014
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Provider Practice Location Address
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Address Line | 5901 HARPER DR NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-3587
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Country | US
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Telephone | 505-823-8545
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Fax | 505-823-8549
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Provider Business Mailing Address
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Address Line | PO BOX 90550
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City | ALBUQUERQUE
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State | NM
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Zip | 87199-0550
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Country | US
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Telephone | 505-768-1333
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Fax | 505-244-9566
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Authorized Official
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Title or Position | CFO
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Name | MRS. JANICE E. YOUNG
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Credential |
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Telephone | 505-246-2622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 3087
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License Number State | NM
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